17-002689/AABS v Aviva Insurance Canada

Jan 08, 2018

Adjudicator: Derek Grant

Issues:

1. Is the applicant entitled to receive a medical benefit in the amount of $4,124.88 for chiropractic services, recommended by Kingsbury Family Chiropractic as detailed in a treatment plan dated March 19, 2015?

2. Is the applicant entitled to interest on any overdue payment of benefits?

3. Is the applicant entitled to costs due to unreasonable, frivolous, vexatious or bad faith actions on the part of Aviva?

Result:

1. The applicant is not entitled to the treatment plan in dispute. There is a lack of objective supporting evidence available to justify the need for additional chiropractic services. The applicant’s failure to produce such information confirms the finding that the treatment plan is neither reasonable nor necessary.